Electrocardiogram Classification with Transformers Using Koopman and Wavelet Features

Automatic 12-lead electrocardiogram (ECG) classification requires representations that jointly capture local waveform morphology, long-range temporal dynamics, and cross-lead dependencies, yet integrating these properties within a single efficient architecture remains challenging. This paper introduces a hybrid CNN-SSM-Attention backbone for 12-lead ECG classification. A convolutional stem performs early waveform tokenization and temporal reduction, mixed state-space and depthwise-convolutional blocks model temporal dynamics and local morphology, and a late self-attention stage enables global token interaction at reduced resolution. To improve transfer from unlabeled data, we further develop an ECG-oriented Joint-Embedding Predictive Pretraining (JEPA) framework. Unlike ViT-based JEPA methods that mask patch tokens before the encoder, the proposed method samples span masks at the latent temporal resolution and projects them back to the waveform domain, then predicts clean latent targets from a momentum encoder without waveform reconstruction. Experiments on CPSC2018, Chapman-Shaoxing, and PTB-XL, with pretraining on approximately 350K unlabeled CODE-15 recordings, show that the proposed backbone provides strong supervised baselines under a compact parameter budget. JEPA pretraining further improves transfer, particularly in reduced-label settings and under both full fine-tuning and LoRA-based adaptation. Code: https://github.com/yakoubbazi/Hybrid_ECG_Jepa

Vision Transformers have shown tremendous success in numerous computer vision applications; however, they have not been exploited for stress assessment using physiological signals such as Electrocardiogram (ECG). In order to get the maximum benefit from the vision transformer for multilevel stress assessment, in this paper, we transform the raw ECG data into 2D spectrograms using short time Fourier transform (STFT). These spectrograms are divided into patches for feeding to the transformer encoder. We also perform experiments with 1D CNN and ResNet-18 (CNN model). We perform leave-onesubject-out cross validation (LOSOCV) experiments on WESAD and Ryerson Multimedia Lab (RML) dataset. One of the biggest challenges of LOSOCV based experiments is to tackle the problem of intersubject variability. In this research, we address the issue of intersubject variability and show our success using 2D spectrograms and the attention mechanism of transformer. Experiments show that vision transformer handles the effect of intersubject variability much better than CNN-based models and beats all previous state-of-the-art methods by a considerable margin. Moreover, our method is end-to-end, does not require handcrafted features, and can learn robust representations. The proposed method achieved 71.01% and 76.7% accuracies with RML dataset and WESAD dataset respectively for three class classification and 88.3% for binary classification on WESAD.

Tokenization determines both the physiological content presented to an ECG Transformer and the sequence over which attention operates. We compare eight tokenization strategies across Transformer, Informer, Reformer, and FEDformer on the nine-label CPSC2018 classification task. The input projection and principal backbone capacity are controlled to isolate the effect of token construction. Median-beat and HeartLang tokenization achieve mean macro-AUCs of 0.893 and 0.889 across the four backbones, compared with 0.822 and 0.824 for point-wise and patch-wise tokenization. Pooling the two physiology-aware representations yields an 8.2% relative improvement in macro-AUC. They also reduce mean sequence length from 1,250 to 158 tokens and mean peak training memory from 5.21 to 0.27 GB. The results show that aligning tokens with ECG morphology can improve both predictive performance and memory efficiency without increasing backbone capacity. The source code is available on https://github.com/LeeJarvis996/ecg_tokenizer.